Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population‐based analysis

Wu, Lu; Tsilimigras, Diamantis I.; Farooq, Ayesha; Hyer, J. Madison; Merath, Katiuscha; Paredes, Anghela Z.; Mehta, Rittal; Sahara, Kota; Shen, Feng; Pawlik, Timothy M.

doi:10.1002/cncr.32396

Cited by 34 publications

(56 citation statements)

References 21 publications

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“…In this study, we found that regardless of the patients age, the prognosis of patients of TNM stage I-II was signi cantly better than that of patients with stage III-IV. The results were the same as that of a decade-long and population-based Analysis by Lu Wu et al 29 . For patients at the early stage, radical surgery should rstly be considered this may prolong the DFS and help prevent metastasis.…”

Section: Discussionsupporting

confidence: 81%

Prognostic factors of disease-free survival in postoperative patients with hepatocellular carcinoma

Luo

zhang

Chen

et al. 2020

Preprint

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Background Hepatocellular carcinoma (HCC) is a primary malignancy of the hepatocyte with high risk of invasion, metastasis and poor prognosis, which leads to a high mortality rate in recent years. This study aims to investigate the independent prognosis factors of DFS(disease free survival) in hepatocellular carcinoma patients after radical hepatectomy.Methods This study retrospectively analyzed 358 patients admitted to the 1st Affiliated Hospital of Anhui Medical College from December 2009 to December 2014. Categorical variables were analyzed by chi-square test. The survival curve was plotted by kaplan-meier method and tested by log-rank method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors.Results Among the 344 patients with liver cancer, 298 cases (86.63%) are young patients (< 70 years), and 46 cases (13.37%) were elderly patients (≥ 70 years). There were no significant difference in gender, smoking history, alcohol consumption history, Body Mass Index (BMI), number of cancer nodules, tumor diameter, differentiation degree and TNM stage between the young and elderly groups (P > 0.05). However, history of hepatitis B and liver cirrhosis were more common in young patients than elderly (P=0.017, P༝0.000). The Kaplan-Meier curves indicated that elderly patients (higher than 70 years), TNM I-II stage and no history of hepatitis B had longer DFS. The univariate and multivariate analyses showed that age, TNM stage, History of hepatitis B were the independent factors for DFS.Conclusions Our findings suggested that age, TNM stage, history of hepatitis B were independent factors for predicting DFS of primary hepatocellular carcinoma patients. Patients older than 70 years had a better prognosis than young patients. Patients with early TNM stage and no history of hepatitis B had longer DFS.

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Section: Discussionsupporting

confidence: 81%

Prognostic factors of disease-free survival in postoperative patients with hepatocellular carcinoma

Luo

zhang

Chen

et al. 2020

Preprint

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“…Nevertheless, in our study, there was no difference in the recurrence pattern between the sarcomatoid and high-grade HCC groups, perhaps due to their similar histological differentiation. Several previous studies have also indicated that the OS of sarcomatoid HCC patients is significantly worse than that of conventional HCC patients, with a 3-year OS rate ranging from 8.0% to 17.5%[ 2 , 8 , 12 , 21 ]. Consistent with previous studies, the current study showed that patients with resected sarcomatoid HCC had an elevated risk of death, with an abysmal 3-year OS compared with the prognosis of resected high-grade HCC patients (17.3% vs 53.4%, P < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma

Wang¹,

Yao²,

Sun³

et al. 2020

WJG

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BACKGROUND Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the fourth leading cause of cancer-related death worldwide. Sarcomatoid HCC, which contains poorly differentiated carcinomatous and sarcomatous components, is a rare histological subtype of HCC that differs from conventional HCC. It is highly aggressive and has a poor prognosis. Its clinicopathological characteristics, surgical outcomes and underlying mechanisms of its highly aggressive nature have not been fully elucidated. AIM To examine the clinicopathological characteristics and surgical outcomes of sarcomatoid HCC and explore the histogenesis of sarcomatoid HCC. METHODS In total, 196 patients [41 sarcomatoid HCC and 155 high-grade (Edmondson-Steiner grade III or IV) HCC] who underwent surgical resection between 2007 and 2017 were retrospectively reviewed. The characteristics and surgical outcomes of sarcomatoid HCC were compared with those of patients with high-grade HCC. The histological composition of invasive and metastatic sarcomatoid HCCs was evaluated. RESULTS Sarcomatoid HCC was more frequently diagnosed at an advanced stage with a larger tumor and higher rates of nonspecific symptom, adjacent organ invasion and lymph node metastasis than high-grade HCC (all P < 0.05). Compared with high-grade HCC patients, sarcomatoid HCC patients are less likely to have typical dynamic imaging features of HCC (44.4% vs 72.7%, P = 0.001) and elevated serum alpha-fetoprotein levels (> 20 ng/mL; 36.6% vs 78.7%, P < 0.001). The sarcomatoid group had a significantly shorter median recurrence-free survival (5.6 mo vs 16.4 mo, log-rank P < 0.0001) and overall survival (10.5 mo vs 48.1 mo, log-rank P < 0.0001) than the high-grade group. After controlling for confounding factors, the sarcomatoid subtype was identified as an independent predictor of poor prognosis. Pathological analyses indicated that invasive and metastatic lesions were mainly composed of carcinomatous components. CONCLUSION Sarcomatoid HCC was associated with a more advanced stage, atypical dynamic imaging, lower serum alpha-fetoprotein levels and a worse prognosis. The highly aggressive nature of sarcomatoid HCC is perhaps mediated by carcinomatous components.

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“…SHC is characterized by a high degree of malignancy, rapid progression, and poor prognosis. The 5-year overall survival (OS) of patients with SHC was found to be worse than that of patients with conventional HCC (5.7% vs 30.1%)[ 5 ]. A lack of specificity is associated with clinical manifestation and etiology of SHC[ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Achievement of complete response to nivolumab in a patient with advanced sarcomatoid hepatocellular carcinoma: A case report

Zhu

Yuan

et al. 2020

WJGO

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BACKGROUND Sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of hepatocellular carcinoma (HCC), with a high recurrence rate after surgery. In addition to limited effective treatment for the advanced stage of SHC, the prognosis of patients with this malignancy is worse than that of patients with conventional HCC. CASE SUMMARY We present the case of a 54-year-old man with SHC who underwent radical segmental hepatectomy, which relapsed 4 mo after surgery due to lymphatic metastasis in the porta hepatis. Although a second surgery was performed, new metastasis developed in the mediastinal lymph nodes. Therefore, sorafenib and lenvatinib were sequentially administered as first- and second-line systemic therapies, respectively. However, progressive disease was confirmed based on a recurrent hepatic lesion and new metastatic lesion in the abdominal cavity. Percutaneous transhepatic cholangial drainage was performed to alleviate the biliary obstruction. Because the tumor was strongly positive for programmed death-ligand 1, the patient was started on nivolumab. Imaging studies revealed that after two cycles of immunotherapy, the metastatic lesions decreased to undetectable levels. CONCLUSION The patient experienced continuous complete remission for 8 mo. Immune checkpoint inhibitors are useful for the treatment of advanced SHC.

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Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population‐based analysis

Cited by 34 publications

References 21 publications

Prognostic factors of disease-free survival in postoperative patients with hepatocellular carcinoma

Prognostic factors of disease-free survival in postoperative patients with hepatocellular carcinoma

Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma

Achievement of complete response to nivolumab in a patient with advanced sarcomatoid hepatocellular carcinoma: A case report

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